Serial Follow-up MR Imaging after Gamma Knife Radiosurgery for Vestibular Schwannoma
|
|
- Malcolm Lester
- 5 years ago
- Views:
Transcription
1 AJNR Am J Neuroradiol 21: , September 2000 Serial Follow-up MR Imaging after Gamma Knife Radiosurgery for Vestibular Schwannoma Hiroyuki Nakamura, Hidefumi Jokura, Kou Takahashi, Nagatoshi Boku, Atsuya Akabane, and Takashi Yoshimoto BACKGROUND AND PURPOSE: Gamma knife radiosurgery has become an important treatment option for vestibular schwannoma. The effect of treatment can be assessed only by neuroimaging. We analyzed the evolution of follow-up MR imaging findings after gamma knife radiosurgery to provide information for the clinical management of these tumors. METHODS: Changes in tumor volume and enhancement were assessed visually on 341 follow-up MR studies obtained in 78 of 86 consecutive patients with unilateral vestibular schwannoma who underwent gamma knife radiosurgery. RESULTS: Follow-up MR studies were obtained between 10 and 63 months (mean, 34 months) after treatment. Tumor control rate was 81%. Changes in tumor volume were classified as temporary enlargement (41%), no change or sustained regression (34%), alternating enlargement and regression (13%), or continuous enlargement (12%). Temporary enlargement occurred within 2 years after radiosurgery. Changes in tumor enhancement were classified as transient loss of enhancement (84%), continuous increase in enhancement (5%), or no change in enhancement (11%). There was no significant correlation between changes in tumor volume and tumor enhancement. Areas of T2 hyperintensity in adjacent brain tissue appeared in 31% of patients. CONCLUSION: Dynamic changes in vestibular schwannoma are seen on serial follow-up MR studies obtained after gamma knife radiosurgery. An increase in tumor size up to 2 years after radiosurgery is likely to be followed by regression. Changes in contrast enhancement are not predictive of clinical outcome. Neuroimaging follow-up is recommended. Gamma knife radiosurgery was first used to treat vestibular schwannomas in 1969 (1). The relatively high peripheral radiation dose of about 20 Gy achieved a good rate of tumor control with a low rate of cranial nerve dysfunction as compared with microsurgical resection at that time (2). However, the high radiation doses were associated with unacceptable complication rates relative to the improved results obtained by modern surgical techniques. Subsequently, radiation doses were significantly reduced, and 12 to 16 Gy is now used in many centers for the greatest benefit and least risk of complications (3 12). The good results have encouraged the adoption of gamma knife radiosur- Received July 6, 1999; accepted after revision February 20, From the Department of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan (H.N., H.J., A.A., T.Y.), and the Department of Neurosurgery, Jiro Suzuki Memorial Gamma House, Furukawa Seiryou Hospital, Furukawa, Japan (K.T., N.B.). Address reprint requests to Hiroyuki Nakamura, MD, Department of Neurosurgery, Tohoku University School of Medicine, 1 1 Seiryo-machi, Aoba-ku, Sendai , Japan. American Society of Neuroradiology gery as an important treatment option for vestibular schwannoma. The treatment goal of gamma knife radiosurgery for vestibular schwannomas is to arrest tumor growth throughout the patient s life. Follow-up imaging is needed to fully assess the effectiveness of tumor control. Unfortunately, the long-term followup results in several series of patients treated with high peripheral doses (7, 8, 13) are difficult to compare with more recent series of patients treated with low peripheral doses and less than 10 years follow-up (10 12, 14 19). Currently, MR imaging is regarded as the most sensitive neuroimaging technique by which to evaluate tumor response. Optimum clinical management of tumors requires understanding of the changes in MR imaging findings over time and of the implications of these findings for clinical outcome. Previous analyses of serial MR studies obtained after gamma knife radiosurgery for vestibular schwannomas involved only a small series of patients or a small number of follow-up studies per patient (14, 20 22). We describe the serial MR imaging findings in 78 patients with unilateral vestibular schwannoma who underwent gamma knife radiosurgery and analyze the changes in these studies over time to pro- 1540
2 AJNR: 21, September 2000 VESTIBULAR SCHWANNOMA 1541 Treatment Stereotactic radiosurgery was performed with the standard gamma knife technique. Axial and coronal contrast-enhanced T1-weighted MR images were used for dose planning in all cases. The imaging technique included 2D Fourier transform sequences with a 3-mm slice thickness and an interslice gap of 1 mm for tumors with a diameter of more than 1 cm and 3D Fourier transform sequences with a 2-mm slice thickness for tumors with a diameter of less than 1 cm. Contrast-enhanced T1-weighted MR images were acquired 5 minutes after bolus injection of contrast medium (0.1 mmol/kg). Dose planning was done in consideration of tumor size, tumor consistency, hearing acuity, and regrowth after surgery (Fig 1). Doses to the periphery of the tumor (peripheral dose) varied from 10.0 to 17.0 Gy (mean, 13.3 Gy). Maximum tumor doses varied from 11.1 to 40.0 Gy (mean, 26.4 Gy). Treatment isodose (ie, that which enveloped the tumor volume with a maximum dose normalized 100%) varied from 30% to 90%. The peripheral dose coincided with the 50% isodose in 44 cases. The number of isocenters varied from one to 12 per tumor (median, four). FIG 1. Scattergram shows the relationship between tumor volume and peripheral dose. # indicates cystic tumor; only solid component was irradiated. vide data for the follow-up management of vestibular schwannomas after gamma knife radiosurgery. Follow-up MR Imaging Follow-up neuroimaging included contrast-enhanced T1- and T2-weighted sequences at 3, 6, and 12 months during the first year; every 6 months during the second year; and yearly thereafter. If significant changes in tumor size or clinical presentation developed, follow-up studies were increased in frequency to every 3 months until stabilization occurred. Followup MR studies were acquired with the same protocol as that used before treatment. Seventy-eight (91%) of the 86 patients underwent one or more MR studies at least 10 months after gamma knife radiosurgery. The last follow-up MR studies were obtained at less than 12 months in five patients, between 12 and 24 months in 19 patients, between 24 and 36 months in 23 patients, and at more than 36 months in 31 patients (range, months; mean, 34 months). Tumor control rate was calculated in these patients. Six patients rejected neuroimaging follow-up. None of these patients showed remarkable symptoms after gamma knife radiosurgery. Two patients, ages 79 and 74 years, respectively, died of unrelated causes after gamma knife radiosurgery for vestibular schwannoma. Sixty-one patients (71%) had serial follow-up MR studies. In all, 341 follow-up studies were available for detailed analysis, with a mean of 5.6 studies per patient. Methods Patients Eighty-six patients with unilateral vestibular schwannoma underwent gamma knife radiosurgery with a Leksell Gamma Unit (Elekta Instruments, Atlanta, GA) between November 1991 and April Selection for gamma knife radiosurgery required that the maximum tumor diameter be less than 40 mm. Gamma knife radiosurgery was recommended for patients who were elderly or in poor medical condition, who had a tumor in the only hearing ear, or who had regrowth after partial removal of a tumor. Patients with a tumor that could be treated by either surgical resection or gamma knife radiosurgery were allowed to decide which alternative they preferred after receiving an adequate explanation of the treatment options. Patients ranged in age from 23 to 79 years (mean, 53 years) and included 31 men and 55 women. Twenty-three patients (27%) had undergone previous surgical resection. Tumor volume varied from 0.2 to 20.1 mm 3 (mean, 6.0 mm 3 ) (Fig 1). Sixty-four tumors were solid and 22 had cystic components (mixed tumor). Analysis of Images Tumor volume was calculated on each MR study by the following method. Maximum tumor diameter was measured in three dimensions (transverse and longitudinal on the axial images, and vertical on the coronal images) using fine calipers. Measurements were defined as x, y, and z, respectively. Tumor volume was xyz/2 (23). Tumor control rate was estimated by comparing tumor volume at the time of treatment with that at the last follow-up. A tumor was considered to be controlled if it showed either no change or regression. The rate of measurement error tends to be in inverse proportion to tumor volume; therefore, tumors were categorized according to calculated tumor volume as small ( 2 mm 3 ), medium (2 8 mm 3 ), or large ( 8 mm 3 ). Significant change was categorized as more than 20%, more than 15%, or more than 10% of tumor volume. These figures correspond to 1 mm change in each given volume (ie, a volume of more than 2 mm 3 20%). The pattern of changes in tumor volume was examined by plotting the ratio of tumor volume at each follow-up study to that at treatment. Univariate analysis was used to evaluate the correlation between tumor volume and tumor control rate. For the purpose of evaluating the correlation between tumor consistency and tumor control rate, univariate analysis was also used to compare tumor control rates between the solid and mixed tumors. Changes in contrast enhancement of the tumor over time were analyzed on serial MR studies for each patient; the degree of contrast enhancement of the tumor was assessed visually on each MR study. T2-weighted images were inspected for new areas of signal hyperintensity in adjacent brain tissue. The correlation between occurrence of hyperintensity and initial tumor volume, peripheral dose, maximum dose, peripheral isodose, and history of prior surgery was evaluated by multivariate analysis. Statistical analyses were performed using Stat View 4.5J (Abacus Concepts, Berkeley, CA). The 2 -test was used to evaluate the correlation between changes in tumor volume and
3 1542 NAKAMURA AJNR: 21, September 2000 FIG 2. Graphs showing the change in the ratio of tumor volume on follow-up MR examinations to tumor volume at treatment over time. A, Tumor shows temporary enlargement. B, Tumor shows no change or sustained regression without temporary enlargement. C, Tumor shows repeated alternate enlargement and regression. D, Tumor shows continuous enlargement. contrast enhancement. Univariate or multivariate analysis was performed with the Cox proportional hazards model. P values less than.05 were considered significant. Results Changes in Tumor Volume Among the 78 patients in whom follow-up studies were available, 47 showed tumor regression, 16 showed no change, and 15 showed tumor enlargement. In two patients, tumor enlargement occurred after gamma knife radiosurgery, so microsurgical resection was performed at the referral hospital. The tumor control rate was 81%. The correlation between tumor control rate and tumor volume was not statistically significant. The rate of tumor regression was significantly greater for mixed tumors than for solid tumors. Changes in tumor volume were categorized into the following four patterns: 1) initial enlargement followed by sustained regression (although not necessarily reverting to initial size), termed temporary enlargement (n 25) (Figs 2A and 3); 2) no change, or sustained regression (n 21) (Figs 2B and 4); 3) repeated alternate enlargement and regression (n 8) (Figs 2C and 5); and 4) continuous enlargement (n 7) (Figs 2D and 6). Most tumors that showed temporary enlargement
4 AJNR: 21, September 2000 VESTIBULAR SCHWANNOMA 1543 FIG 3. Serial contrast-enhanced axial T1-weighted images (450/17/5) in a 51-year-old man. Note that the tumor shows temporary enlargement with transient loss of contrast enhancement 3 months after treatment. GKRS indicates gamma knife radiosurgery; mos., months after gamma knife radiosurgery. FIG 4. Serial contrast-enhanced axial T1-weighted images (450/17/5) in a 25-year-old woman. Note that the tumor shows no change in size with transient loss of contrast enhancement 6 months after treatment and thereafter the tumor shows continuous regression with recovery of contrast enhancement. GKRS indicates gamma knife radiosurgery; mos., months after gamma knife radiosurgery. FIG 5. Serial contrast-enhanced axial T1-weighted images (450/17/5) in a 64-year-old woman show enlargement of the cystic component and transient loss of contrast enhancement in the solid component at 3 months; regression of the cystic component, slight enlargement and recovery of contrast enhancement of the solid component, and slight regression of the overall tumor at 18 months; further enlargement of the solid component, no change in the cystic component, and regression of the overall tumor at 24 months; and remarkable regression of the tumor at 50 months. GKRS indicates gamma knife radiosurgery; mos., months after gamma knife radiosurgery. reached their peak within 1 year and regressed within 2 years. Maximum temporary enlargement was double the initial tumor volume in some cases. In six of seven patients with a pattern of continuous tumor enlargement, the enlargement persisted for more than 2 years. Follow-up MR studies in all patients with controlled tumor over 3 years showed no significant change in tumor volume. Five of the eight patients with a pattern of alternating changes had tumors that repeatedly showed enlargement and/or collapse of the cystic component. Followup MR studies revealed fluid-fluid levels in five of 22 patients with cystic components in the tumor. Changes in Contrast Enhancement Changes in tumor contrast enhancement could be divided into the following three patterns: 1) initial decrease of contrast enhancement followed by recovery of enhancement in the central area, termed transient loss of contrast enhancement (n 51) (Figs 3, 4, and 6); 2) continuous increase in con-
5 1544 NAKAMURA AJNR: 21, September 2000 FIG 6. Serial contrast-enhanced axial T1-weighted images (250/25/1 at treatment, 400/15/2 at 6 months, and 400/15/4 at 12 months and 18 months after treatment) in a 55-year-old woman. Note the continuous enlargement of the tumor, although with transient loss of contrast enhancement. GKRS indicates gamma knife radiosurgery; mos., months after gamma knife radiosurgery. FIG 7. Serial contrast-enhanced axial T1-weighted images (250/30/1 at treatment, 400/17/3 at 7 months, 340/16/3 at 20 months, and 250/30/1 at 42 months after treatment) in a 42-year-old woman showing continuous increase in contrast enhancement without transient loss of contrast enhancement. GKRS indicates gamma knife radiosurgery; mos., months after gamma knife radiosurgery. FIG 8. Serial contrast-enhanced axial T1-weighted images (450/17/5 at treatment and 500/15/2 at each follow up) in a 52-year-old woman show tumor regression but almost no change in contrast enhancement. GKRS indicates gamma knife radiosurgery; mos., months after gamma knife radiosurgery. trast enhancement (n 3) (Fig 7); and 3) no change in contrast enhancement (n 7) (Fig 8). The onset of a transient loss of contrast enhancement ranged from 2 to 12 months (median, 4 months), and recovery of contrast enhancement appeared from 7 to 35 months (median, 12 months). The onset of increased contrast enhancement ranged from 5 to 28 months (median, 14 months). We found no significant correlation between contrast enhancement and pattern of change in tumor volume (Fig 9). Changes in Adjacent Brain In 19 patients, T2-weighted MR images showed new areas of hyperintensity in adjacent brain tissue, which appeared from 3 to 37 months (mean, 12 months) after gamma knife radiosurgery (Fig 10). These findings disappeared or improved partially in 14 patients and persisted for over 2 years in three patients. These areas of hyperintensity did not correlate significantly with initial tumor volume, peripheral dose, maximum dose, peripheral isodose, or history of previous surgery.
6 AJNR: 21, September 2000 VESTIBULAR SCHWANNOMA 1545 FIG 9. Bar graph shows the correlation between changes in tumor volume and contrast enhancement. Vol. I indicates temporary enlargement; Vol. II, no change or sustained regression; Vol. III, alternate enlargement and regression repeatedly; Vol. IV, continuous enlargement; CE. I, transient loss of contrast enhancement followed by recovery of enhancement; CE. II, continuous increase in enhancement; CE. III, no change in enhancement. Discussion In our series, the tumor control rate was 81%. However, eight of the 13 tumors judged as enlarged at the last follow-up had regressed after temporary enlargement. If these tumors are also considered to be controlled, then the control rate becomes 91%. These results are comparable to those of other series. Flickinger et al (5) treated 134 patients with 136 vestibular schwannomas with 12 to 20 Gy (median, 17 Gy) to the periphery of the tumors and found that tumor regressed in 42% and enlarged in 3% at a mean of 24 months follow-up (range, 6 56 months). The actuarial tumor control rate was %. In another study (13), evaluation of 174 patients, including those treated with high doses (25 to 35 Gy), followed up for a mean of 54 months (range, months), found tumor regression in 56%, no change in 32%, and enlargement in 12%, with a tumor control rate of 88%. The outcomes for low- and high-dose treatment were not given separately; however, the early results of low-dose treatment showed no decrease in tumor control rate as compared with the results of high-dose treatment. Technological advancements in computerized dose planning and MR imaging techniques, which were not available in the early period, may have compensated for the reduction of delivered doses. An understanding of the patterns of tumor behavior observed during follow-up MR imaging after gamma knife radiosurgery is important to offset the limited follow-up periods available for patients undergoing low-dose treatment and to predict the long-term effects of treatment. Initial enlargement followed by arrest of growth or regression (ie, temporary enlargement, as defined in our series) has been reported (7, 17, 20, 22, 24). Temporary enlargement was reported in 6% of 193 unilateral vestibular schwannomas (7) and in two of 10 tumors in another series (24). In our study, as many as 41% of tumors treated by gamma knife radiosurgery showed temporary enlargement. This high rate of temporary enlargement detected by close neuroimaging follow-up of the patients in our series suggests that temporary enlargement is more common after gamma knife radiosurgery for vestibular schwannomas than previously reported. Microsurgical resection of tumors that have enlarged after gamma knife radiosurgery has shown hyalinized thrombosis, thickening of the vascular wall, vascular obstruction, and granulomatous change (16, 17). We believe that these failures in fact represent a stage of temporary enlargement that follows treatment. Such temporary enlargement is a biological response to radiation and complicates the interpretation of MR images in the early period after gamma knife radiosurgery. Therefore, we recommend that tumor enlargement identified at follow-up neuroimaging not associated with aggravation of signs and symptoms be followed closely by serial neuroimaging for at least 2 years after radiosurgery. In most patients, tumor volume tends to stabilize after 3 years (Fig 2), indicating the importance of monitoring tumor size with neuroimaging within the first 3 years after treatment. Large tumors were treated with lower doses than those applied to small tumors (Fig 1), but large tumors responded to gamma knife radiosurgery as well as small tumors in our series. The effective- FIG 10. Serial axial T2-weighted images (2000/110/2 at treatment, 3400/100/4 at 6 months and 4000/100/3 at 10 months and 36 months after treatment) in a 52-year-old woman. Note the hyperintensity in the adjacent brain tissue at 6 months and remarkable improvement at 10 months. GKRS indicates gamma knife radiosurgery; mos., months after gamma knife radiosurgery.
7 1546 NAKAMURA ness of gamma knife radiosurgery for cystic tumors compared favorably with that for solid tumors. However, cystic tumors tended to show alternating increase and decrease of tumor volume with time. Two of seven patients with continuous enlargement of the tumor showed enlargement of only the cystic component, with continuous regression of the solid component. Enlargement of the cystic component of the tumor may occur regardless of the effectiveness of gamma knife radiosurgery. Therefore, changes in the cystic component cause the alternating changes in the tumor volume and the unpredictable behavior of the tumor. Minor hemorrhage from the cyst wall may be responsible for enlargement of the cystic component, because some tumors show fluid-fluid levels on follow-up MR studies. Transient loss of contrast enhancement occurred in 84% of the tumors in our series. Others have reported transient loss of contrast enhancement in 70% (8) and 79% (21) of treated schwannomas, and this was found to be a good prognostic indicator of tumor regression (25). In our series, continuous enlargement was found in five tumors that showed transient loss of contrast enhancement, a condition that may result from radiation-induced vascular injury and occlusion. Obliteration of blood supply to the tumor may be one of the major mechanisms controlling tumor growth after radiosurgery (25). However, five of seven tumors with no change in contrast enhancement showed regression, so other mechanisms must be important for controlling tumor growth. We believe that a transient loss of contrast enhancement does not necessarily predict subsequent tumor regression. Conclusion Serial MR studies of unilateral vestibular schwannomas treated with gamma knife radiosurgery showed that temporary enlargement of tumor occurred in 41% of cases. Temporary enlargement occurred mostly within the first 2 years after radiosurgery. Subsequent regression of tumor volume occurred during and after the second year following radiosurgery. Because such enlargement within 2 years after gamma knife radiosurgery is usually followed by regression, close follow-up with neuroimaging is desirable in these cases. Transient loss of contrast enhancement after gamma knife radiosurgery was recognized in most cases, but was not necessarily a useful prognostic sign. Gamma knife radiosurgery for vestibular schwannomas was effective for both small and large tumors up to 4 cm in largest diameter and for solid tumors and tumors with cystic components. However, the behavior of the cystic component can make the tumor volume unpredictable. Serial MR studies may show that the tumor is stable after the third year following radiosurgery. References AJNR: 21, September Leksell L. A note on the treatment of acoustic tumours. Acta Chir Scand 1971;137: Noren G, Arndt J, Hindmarsh T. Stereotactic radiosurgery in cases of acoustic neurinoma: further experiences. Neurosurgery 1983;13: Mendenhall WM, Friedman WA, Bova FJ. Linear acceleratorbased stereotactic radiosurgery for acoustic schwannomas [see comments]. Int J Radiat Oncol Biol Phys 1994;28: Lunsford LD, Kondziolka D, Flickinger JC. Stereotactic radiosurgery for benign intracranial tumors. Clin Neurosurg 1993; 40: Flickinger JC, Lunsford LD, Linskey ME, Duma CM, Kondziolka D. Gamma knife radiosurgery for acoustic tumors: multivariate analysis of four year results. Radiother Oncol 1993;27: Flickinger JC, Kondziolka D, Pollock BE, Lunsford LD. Evolution in technique for vestibular schwannoma radiosurgery and effect on outcome. Int J Radiat Oncol Biol Phys 1996;36: Noren G, Greitz D, Hirsch A, Lax I. Gamma knife surgery in acoustic tumours. Acta Neurochir Suppl (Wien) 1993;58: Noren G, Karlbom A, Brantberg K, Lax I, Mosskin M. Gamma knife radiosurgery for acoustic neurinomas. Neurosurgeons 1995;14: Pollock BE, Lunsford LD, Kondziolka D, et al. Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery [published erratum appears in Neurosurgery 1995; 36:427]. Neurosurgery 1995;36: Koos WT, Matula C, Levy D, Kitz K. Microsurgery versus radiosurgery in the treatment of small acoustic neurinomas. Acta Neurochir Suppl (Wien) 1995;63: Jokura H, Yoshimoto T. Gamma knife radiosurgery for acoustic neurinoma: history and present situation [in Japanese]. No To Shinkei 1996;48: Ito K, Kurita H, Sugasawa K, Okuno T, Mizuno M, Sasaki T. Neuro-otological findings after radiosurgery for acoustic neurinomas. Arch Otolaryngol Head Neck Surg 1996;122: Noren G, Greitz D, Hirsch A, Lax I. Gamma knife radiosurgery in acoustic neurinoma. In: Steiner L, et al.eds. Radiosurgery: Baseline and Trends. New York: Raven; 1992: To SY, Lufkin RB, Rand R, Robinson JD, Hanafee W. Volume growth rate of acoustic neuromas on MRI post-stereotactic radiosurgery. Comput Med Imaging Graph 1990;14: Foote RL, Coffey RJ, Swanson JW, et al. Stereotactic radiosurgery using the gamma knife for acoustic neuromas. Int J Radiat Oncol Biol Phys 1995;32: Hirato M, Inoue H, Nakamura M, et al. Gamma knife radiosurgery for acoustic schwannoma: early effects and preservation of hearing. Neurol Med Chir (Tokyo) 1995;35: Kobayashi T, Tanaka T, Kida Y. The early effects of gamma knife on 40 cases of acoustic neurinoma. Acta Neurochir Suppl (Wien) 1994;62: Yamamoto M, Noren G. Stereotactic radiosurgery in acoustic neurinomas [in Japanese]. No Shinkei Geka 1990;18: Linskey ME, Lunsford LD, Flickinger JC, Kondziolka D. Stereotactic radiosurgery for acoustic tumors. Neurosurg Clin N Am 1992;3: Yamamoto M, Ide M, Umebara Y, Hagiwara S, Jimbo M, Takakura K. Gamma knife radiosurgery for brain tumors: postirradiation volume changes compared with preradiosurgical growth fractions. Neurol Med Chir (Tokyo) 1996;36: Linskey ME, Lunsford LD, Flickinger JC. Neuroimaging of acoustic nerve sheath tumors after stereotaxic radiosurgery. AJNR Am J Neuroradiol 1991;12: Oyama H, Kobayashi T, Kida Y, et al. Early changes in volume and non-enhanced volume of acoustic neurinoma after stereotactic gamma-radiosurgery. Neurol Med Chir (Tokyo) 1994;34: Petersen OF, Espersen JO. Extradural hematomas: measurement of size by volume summation on CT scanning. Neuroradiology 1984;26: Ogunrinde OK, Lunsford LD, Flickinger JC, Kondziolka DS. Cranial nerve preservation after stereotactic radiosurgery for small acoustic tumors. Arch Neurol 1995;52: Linskey ME, Lunsford LD, Flickinger JC. Radiosurgery for acoustic neurinomas: early experience. Neurosurgery 1990;26:
Results of acoustic neuroma radiosurgery: an analysis of 5 years experience using current methods
See the Letter to the Editor and the Response in this issue in Neurosurgical Forum, pp 141 142. J Neurosurg 94:1 6, 2001 Results of acoustic neuroma radiosurgery: an analysis of 5 years experience using
More informationLONG-TERM FOLLOW-UP OF ACOUSTIC SCHWANNOMA RADIOSURGERY WITH MARGINAL TUMOR DOSES OF 12 TO 13 Gy
doi:10.1016/j.ijrobp.2007.01.001 Int. J. Radiation Oncology Biol. Phys., Vol. 68, No. 3, pp. 845 851, 2007 Copyright 2007 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/07/$ see front
More informationThe New England Journal of Medicine LONG-TERM OUTCOMES AFTER RADIOSURGERY FOR ACOUSTIC NEUROMAS
LONG-TERM OUTCOMES AFTER RADIOSURGERY FOR ACOUSTIC NEUROMAS DOUGLAS KONDZIOLKA, M.D., L. DADE LUNSFORD, M.D., MARK R. MCLAUGHLIN, M.D., AND JOHN C. FLICKINGER, M.D. ABSTRACT Background Stereotactic radiosurgery
More informationORIGINAL ARTICLE. Hearing Loss and Changes in Transient Evoked Otoacoustic Emissions After Gamma Knife Radiosurgery for Acoustic Neurinomas
ORIGINAL ARTICLE Hearing Loss and Changes in Transient Evoked Otoacoustic Emissions After Gamma Knife Radiosurgery for Acoustic Neurinomas Francesco Ottaviani, MD; Cesare Bartolomeo Neglia, MD; Laura Ventrella,
More informationDECISION MAKING IN AVM TREATMENT STRATEGY TREATMENT BOARD SYSTEM AT TOHOKU UNIVERSITY
Kitakanto Med. J. (S1) : 79-84, 1998 79 DECISION MAKING IN AVM TREATMENT STRATEGY TREATMENT BOARD SYSTEM AT TOHOKU UNIVERSITY Takashi Yoshimoto, Hidefumi Jokura Department of Neurosurgery, Tohoku University
More informationStereotactic radiosurgery in the management of acoustic neuromas associated with neurofibromatosis Type 2
Stereotactic radiosurgery in the management of acoustic neuromas associated with neurofibromatosis Type 2 Brian R. Subach, M.D., Douglas Kondziolka, M.D., M. Sc., F.R.C.S.(C), L. Dade Lunsford, M.D., F.A.C.S.,
More informationFRACTIONATED STEREOTACTIC RADIOTHERAPY FOR ACOUSTIC NEUROMAS
PII S0360-3016(02)02763-3 Int. J. Radiation Oncology Biol. Phys., Vol. 54, No. 2, pp. 500 504, 2002 Copyright 2002 Elsevier Science Inc. Printed in the USA. All rights reserved 0360-3016/02/$ see front
More informationCyberknife Radiotherapy for Vestibular Schwannoma
Cyberknife Radiotherapy for Vestibular Schwannoma GordonT. Sakamoto, MD a, *, Nikolas Blevins, MD b, Iris C. Gibbs, MD c KEYWORDS Stereotactic radiosurgery Vestibular schwannomas Cyberknife Fractionation
More informationS tereotactic radiosurgery, whether delivered by a gamma
1536 PAPER Gamma knife stereotactic radiosurgery for unilateral acoustic neuromas J G Rowe, M W R Radatz, L Walton, A Hampshire, S Seaman, A A Kemeny... See end of article for authors affiliations... Correspondence
More informationHemorrhagic vestibular schwannoma: an unusual clinical entity Case report
Neurosurg Focus 5 (3):Article 9, 1998 Hemorrhagic vestibular schwannoma: an unusual clinical entity Case report Dean Chou, M.D., Prakash Sampath, M.D., and Henry Brem, M.D. Departments of Neurological
More informationRecently, GKS has been regarded as a major therapeutic. Nervus intermedius dysfunction following Gamma Knife surgery for vestibular schwannoma
J Neurosurg 118:566 570, 2013 AANS, 2013 Nervus intermedius dysfunction following Gamma Knife surgery for vestibular schwannoma Clinical article Seong-Hyun Park, M.D., 1 Kyu-Yup Lee, M.D., 2 and Sung-Kyoo
More informationOtolaryngologist s Perspective of Stereotactic Radiosurgery
Otolaryngologist s Perspective of Stereotactic Radiosurgery Douglas E. Mattox, M.D. 25 th Alexandria International Combined ORL Conference April 18-20, 2007 Acoustic Neuroma Benign tumor of the schwann
More informationLong-term follow-up reveals low toxicity of radiosurgery for vestibular schwannoma q
Radiotherapy and Oncology 82 (2007) 83 89 www.thegreenjournal.com Vestibular schwannoma Long-term follow-up reveals low toxicity of radiosurgery for vestibular schwannoma q Isabelle Rutten a, *, Brigitta
More informationVestibular schwannoma (VS), also known as acoustic neuroma
ORIGINAL RESEARCH O.W.M. Meijer E.J. Weijmans D.L. Knol B.J. Slotman F. Barkhof W.P. Vandertop J.A. Castelijns Tumor-Volume Changes after Radiosurgery for Vestibular Schwannoma: Implications for Follow-
More informationGamma knife radiosurgery for Koos grade 4 vestibular schwannomas
Gamma knife radiosurgery for Koos grade 4 vestibular schwannomas David Mathieu MD FRCSC, Christian Iorio-Morin MD PhD, Fahd Al Subaie MD MSc FRCSC Division of neurosurgery, Université de Sherbrooke, Centre
More informationAfter an evolution of more than 3 decades, stereotactic
Neuro-Oncology Advance Access published May 3, 2012 Neuro-Oncology doi:10.1093/neuonc/nos085 NEURO-ONCOLOGY Therapeutic profile of single-fraction radiosurgery of vestibular schwannoma: unrelated malignancy
More informationLinear accelerator radiosurgery for vestibular schwannoma
See the Letter to the Editor and the Response in this issue in Neurosurgical Forum, pp 142 144. J Neurosurg 94:7 13, 2001 Linear accelerator radiosurgery for vestibular schwannoma ROBERTO SPIEGELMANN,
More informationThe Effect of Sub-Pixel MRI shifts on Radiosurgical Dosimetry for Vestibular Schwannomas. Departments of Neurosurgery 1 and Radiation Oncology 2,
The Effect of Sub-Pixel MRI shifts on Radiosurgical Dosimetry for Vestibular Schwannomas. Jonathan A. Borden, M.D. 1, Jen-San Tsai, Ph.D. 2 and Anita Mahajan, M.D. 2 Departments of Neurosurgery 1 and Radiation
More informationStereotactic radiosurgery (SRS) is the least invasive
» This article has been updated from its originally published version to correct Table 1 and terminology in the text. See the corresponding erratum notice, DOI: 10.3171/2017.3.JNS151624a. «CLINICAL ARTICLE
More informationEstimating the Risks of Adverse Radiation Effects After Gamma Knife Radiosurgery for Arteriovenous Malformations
Estimating the Risks of Adverse Radiation Effects After Gamma Knife Radiosurgery for Arteriovenous Malformations Hideyuki Kano, MD, PhD; John C. Flickinger, MD; Daniel Tonetti, MD; Alan Hsu, MD; Huai-che
More informationAc o u s t i c neuromas, also known as vestibular. Predictors of hearing preservation after stereotactic radiosurgery for acoustic neuroma
J Neurosurg 111:863 873, 2009 Predictors of hearing preservation after stereotactic radiosurgery for acoustic neuroma Clinical article Hi d e y u k i Ka n o, M.D., Ph.D., 1,3 Do u g l a s Ko n d z i o
More informationNeurological Change after Gamma Knife Radiosurgery for Brain Metastases Involving the Motor Cortex
ORIGINAL ARTICLE Brain Tumor Res Treat 2016;4(2):111-115 / pissn 2288-2405 / eissn 2288-2413 http://dx.doi.org/10.14791/btrt.2016.4.2.111 Neurological Change after Gamma Knife Radiosurgery for Brain Metastases
More informationDespite recent progress in microsurgical techniques, endovascular
Application of Single-Stage Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations >10 cm 3 Shunya Hanakita, MD; Tomoyuki Koga, MD, PhD; Masahiro Shin, MD, PhD; Hiroshi Igaki, MD, PhD; Nobuhito
More informationWe have previously reported good clinical results
J Neurosurg 113:48 52, 2010 Gamma Knife surgery as sole treatment for multiple brain metastases: 2-center retrospective review of 1508 cases meeting the inclusion criteria of the JLGK0901 multi-institutional
More informationLong-term results of gamma knife surgery for growth hormone producing pituitary adenoma: is the disease difficult to cure?
J Neurosurg (Suppl) 102:119 123, 2005 Long-term results of gamma knife surgery for growth hormone producing pituitary adenoma: is the disease difficult to cure? TATSUYA KOBAYASHI, M.D., PH.D., YOSHIMASA
More informationAcoustic Neuroma. Presenting Signs and Symptoms of an Acoustic Neuroma:
Acoustic Neuroma An acoustic neuroma is a benign tumor which arises from the nerves behind the inner ear and which may affect hearing and balance. The incidence of symptomatic acoustic neuroma is estimated
More informationComparison of Growth Patterns of Acoustic Neuromas With and Without Radiosurgery
Otology & Neurotology 27:705 Y 712 Ó 2006, Otology & Neurotology, Inc. Comparison of Growth Patterns of Acoustic Neuromas With and Without Radiosurgery *Alex Battaglia, Bill Mastrodimos, and *Roberto Cueva
More informationRapid Regrowth of Intracranial Clear Cell Meningioma After Craniotomy and Gamma Knife Radiosurgery
Neurol Med Chir (Tokyo) 44, 321 325, 2004 Rapid Regrowth of Intracranial Clear Cell Meningioma After Craniotomy and Gamma Knife Radiosurgery Case Report Mitsunobu IDE, Masaaki YAMAMOTO, Shinji HAGIWARA,
More informationAbstractID: 8073 Title: Quality Assurance, Planning and Clinical Results for Gamma Knife Radiosurgery S. Goetsch, Ph.D. Page 1 Seattle, WA May 2008
Knife Radiosurgery S. Goetsch, Ph.D. Page 1 Quality Assurance, Planning and Clinical Results for Gamma Knife Radiosurgery Steven J. Goetsch, Ph.D., FAAPM ACMP 25 th Annual Meeting Seattle, WA May 2008
More informationORIGINAL PAPER USEFUL BASE PLATE TO SUPPORT THE HEAD DURING LEKSELL SKULL FRAME PLACEMENT IN GAMMA KNIFE PERFEXION RADIOSURGERY
Nagoya J. Med. Sci. 76. 27 ~ 33, 2014 ORIGINAL PAPER USEFUL BASE PLATE TO SUPPORT THE HEAD DURING LEKSELL SKULL FRAME PLACEMENT IN GAMMA KNIFE PERFEXION RADIOSURGERY HISATO NAKAZAWA 1,2, MSc; YOSHIMASA
More informationRadiosurgical Treatment of Vestibular Schwannomas in Patients With Neurofibromatosis Type 2
Radiosurgical Treatment of Vestibular Schwannomas in Patients With Neurofibromatosis Type 2 Tumor Control and Hearing Preservation Ji Hoon Phi, MD 1, Dong Gyu Kim, MD, PhD 1, Hyun-Tai Chung, PhD 1, Joongyub
More informationAcoustic neuromas (vestibular schwannomas) are generally
CHAPTER 6 Navigating Change and the Acoustic Neuroma Story: Methods, Outcomes, and Myths L. Dade Lunsford, M.D., F.A.C.S., Ajay Niranjan, M.B.B.S., M.Ch., John C. Flickinger, M.D., and Douglas Kondziolka,
More informationLONG-TERM OUTCOME OF STEREOTACTIC RADIOSURGERY (SRS) IN PATIENTS WITH ACOUSTIC NEUROMAS
doi:10.1016/j.ijrobp.2005.10.024 Int. J. Radiation Oncology Biol. Phys., Vol. 64, No. 5, pp. 1341 1347, 2006 Copyright 2006 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/06/$ see front
More informationPII S (01) CLINICAL INVESTIGATION
PII S0360-3016(01)01559-0 Int. J. Radiation Oncology Biol. Phys., Vol. 50, No. 5, pp. 1265 1278, 2001 Copyright 2001 Elsevier Science Inc. Printed in the USA. All rights reserved 0360-3016/01/$ see front
More informationPREDICTION OF COMPLICATIONS IN GAMMA KNIFE RADIOSURGERY OF ARTERIOVENOUS MALFORMATIONS
Acta Oncologica Vol. 35, No. I, pp. 49-55, 1996 PREDICTION OF COMPLICATIONS IN GAMMA KNIFE RADIOSURGERY OF ARTERIOVENOUS MALFORMATIONS INGMAR LAX and BENGT KARLSSON The incidence of complications following
More informationStereotactic Radiosurgery/Fractionated Stereotactic Radiotherapy for Acoustic Neuroma (Vestibular Schwannomas)
Strategic Commissioning Group West Midlands Commissioning Policy (WM/38) Stereotactic Radiosurgery/Fractionated Stereotactic Radiotherapy for Acoustic Neuroma (Vestibular Schwannomas) Version 1 July 2010
More informationGamma Knife surgery for trigeminal schwannoma
J Neurosurg 106:839 845, 2007 Gamma Knife surgery for trigeminal schwannoma JASON SHEEHAN, M.D., PH.D., CHUN PO YEN, M.D., YASSER ARKHA, M.D., DAVID SCHLESINGER, PH.D., AND LADISLAU STEINER, M.D., PH.D.
More informationAlthough histologically benign, tumors LONG-TERM RESULTS AFTER RADIOSURGERY FOR BENIGN INTRACRANIAL TUMORS CLINICAL STUDIES
CLINICAL STUDIES LONG-TERM RESULTS AFTER RADIOSURGERY FOR BENIGN INTRACRANIAL TUMORS Douglas Kondziolka, M.D. Narendra Nathoo, M.D. John C. Flickinger, M.D. Ajay Niranjan, M.Ch. Ann H. Maitz, M.S. L. Dade
More informationGamma Knife Surgery for Brain Metastasis from Renal Cell Carcinoma : Relationship Between Radiological Characteristics and Initial Tumor Response
online ML Comm www.jkns.or.kr Clinical Article Jin Wook Kim, M.D. Jung Ho Han, M.D. Chul-Kee Park, M.D. Hyun-Tai Chung, Ph.D. Sun Ha Paek, M.D. Dong Gyu Kim, M.D. Department of Neurosurgery Seoul National
More informationSurvival and Intracranial Control of Patients With 5 or More Brain Metastases Treated With Gamma Knife Stereotactic Radiosurgery
ORIGINAL ARTICLE Survival and Intracranial Control of Patients With 5 or More Brain Metastases Treated With Gamma Knife Stereotactic Radiosurgery Ann C. Raldow, BS,* Veronica L. Chiang, MD,w Jonathan P.
More informationSUCCESSFUL TREATMENT OF METASTATIC BRAIN TUMOR BY CYBERKNIFE: A CASE REPORT
SUCCESSFUL TREATMENT OF METASTATIC BRAIN TUMOR BY CYBERKNIFE: A CASE REPORT Cheng-Ta Hsieh, 1 Cheng-Fu Chang, 1 Ming-Ying Liu, 1 Li-Ping Chang, 2 Dueng-Yuan Hueng, 3 Steven D. Chang, 4 and Da-Tong Ju 1
More informationForward treatment planning techniques to reduce the normalization effect in Gamma Knife radiosurgery
Received: 7 November 2016 Revised: 9 August 2017 Accepted: 21 August 2017 DOI: 10.1002/acm2.12193 RADIATION ONCOLOGY PHYSICS Forward treatment planning techniques to reduce the normalization effect in
More informationStereotactic Radiosurgery for Skull Base Meningioma
Neurol Med Chir (Tokyo) 49, 456 461, 2009 Stereotactic Radiosurgery for Skull Base Meningioma Hiroshi IGAKI*, **, KeisukeMARUYAMA***, Tomoyuki KOGA***, Naoya MURAKAMI**, Masao TAGO**,,AtsuroTERAHARA**,
More informationThe Risk of Hemorrhage after Radiosurgery for Cerebral Arteriovenous Malformations
The new england journal of medicine original article The Risk of Hemorrhage after Radiosurgery for Cerebral Arteriovenous Malformations Keisuke Maruyama, M.D., Nobutaka Kawahara, M.D., Ph.D., Masahiro
More informationClinical significance of conformity index and gradient index in patients undergoing stereotactic radiosurgery for a single metastatic tumor
CLINICAL ARTICLE J Neurosurg (Suppl) 129:103 110, 2018 Clinical significance of conformity index and gradient index in patients undergoing stereotactic radiosurgery for a single metastatic tumor Hitoshi
More informationUse of the Leksell gamma knife C with automatic positioning system for the treatment of meningioma and vestibular schwannoma
Neurosurg Focus 14 (5):Article 8, 2003, Click here to return to Table of Contents Use of the Leksell gamma knife C with automatic positioning system for the treatment of meningioma and vestibular schwannoma
More informationDelayed Radiation Necrosis With Extensive Brain Edema After Gamma Knife Radiosurgery for Multiple Cerebral Cavernous Malformations
Neurol Med Chir (Tokyo) 43, 391 395, 2003 Delayed Radiation Necrosis With Extensive Brain Edema After Gamma Knife Radiosurgery for Multiple Cerebral Cavernous Malformations Case Report Nobuo TAKENAKA,
More informationANALYSIS OF TREATMENT OUTCOMES WITH LINAC BASED STEREOTACTIC RADIOSURGERY IN INTRACRANIAL ARTERIOVENOUS MALFORMATIONS
ANALYSIS OF TREATMENT OUTCOMES WITH LINAC BASED STEREOTACTIC RADIOSURGERY IN INTRACRANIAL ARTERIOVENOUS MALFORMATIONS Dr. Maitri P Gandhi 1, Dr. Chandni P Shah 2 1 Junior resident, Gujarat Cancer & Research
More informationPOSTOPERATIVE CHRONIC SUBDURAL HEMATOMA FOLLOWING CLIP- PING SURGERY
Nagoya postoperative Med. J., chronic subdural hematoma after aneurysmal clipping 13 POSTOPERATIVE CHRONIC SUBDURAL HEMATOMA FOLLOWING CLIP- PING SURGERY TAKAYUKI OHNO, M.D., YUSUKE NISHIKAWA, M.D., KIMINORI
More informationStereotactic radiosurgery for the treatment of melanoma and renal cell carcinoma brain metastases
ONCOLOGY REPORTS 29: 407-412, 2013 Stereotactic radiosurgery for the treatment of melanoma and renal cell carcinoma brain metastases SHELLY LWU 1, PABLO GOETZ 1, ERIC MONSALVES 1, MANDANA ARYAEE 1, JULIUS
More informationStereotactic Radiosurgery and Stereotactic Body Radiation Therapy
Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy Policy Number: Original Effective Date: MM.05.008 05/12/1999 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST 03/01/2013 Section:
More informationGamma Knife Radiosurgeryin Medium-sized Arteriovenous Malformations: Preliminary Report
Original Article Gamma Knife Radiosurgeryin Medium-sized Arteriovenous Malmations: Preliminary Rept Masaaki YAMAMOTO, M.D.,1 Mitsunobu IDE, M.D.,1 Minu JIMBO, M.D.,1 Kintomo TAKAKURA, M.D.,2 Tatsuo HIRAI,
More informationSeizure control of Gamma Knife radiosurgery for non-hemorrhagic arteriovenous malformations
Acta Neurochir Suppl (2006) 99: 97 101 # Springer-Verlag 2006 Printed in Austria Seizure control of Gamma Knife radiosurgery for non-hemorrhagic arteriovenous malformations Y. J. Lim, C. Y. Lee, J. S.
More informationEvidence Based Medicine for Gamma Knife Radiosurgery. Metastatic Disease GAMMA KNIFE SURGERY
GAMMA KNIFE SURGERY Metastatic Disease Evidence Based Medicine for Gamma Knife Radiosurgery Photos courtesy of Jean Régis, Timone University Hospital, Marseille, France Brain Metastases The first report
More informationInjury to the facial nerve is a common complication. Efficacy of facial nerve sparing approach in patients with vestibular schwannomas
See the corresponding editorial in this issue, pp 915 916. J Neurosurg 115:917 923, 2011 Efficacy of facial nerve sparing approach in patients with vestibular schwannomas Clinical article Raqeeb Haque,
More informationGamma Knife radiosurgery for large vestibular schwannomas greater than 3 cm in diameter
CLINICAL ARTICLE J Neurosurg 128:1380 1387, 2018 Gamma Knife radiosurgery for large vestibular schwannomas greater than 3 cm in diameter Cheng-Wei Huang, MD, 1,4 Hsien-Tang Tu, BS, 1 Chun-Yi Chuang, MD,
More informationIMAGE-GUIDED RADIOSURGERY USING THE GAMMA KNIFE
IMAGE-GUIDED RADIOSURGERY USING THE GAMMA KNIFE L. D. LUNSFORD INTRODUCTION Image guided brain surgery became a reality in the mid-1970s after the introduction of the first methods to obtain axial imaging
More informationLINAC Radiosurgery and Radiotherapy Treatment of Acoustic Neuromas
Otolaryngol Clin N Am 40 (2007) 541 570 LINAC Radiosurgery and Radiotherapy Treatment of Acoustic Neuromas Ilya Likhterov, BA a, Robert M. Allbright, MD b, Samuel H. Selesnick, MD c,d,e, * a Weill Cornell
More informationStereotactic Radiosurgery of World Health Organization Grade II and III Intracranial Meningiomas
Stereotactic Radiosurgery of World Health Organization Grade II and III Intracranial Meningiomas Treatment Results on the Basis of a 22-Year Experience Bruce E. Pollock, MD 1,2 ; Scott L. Stafford, MD
More informationInfluenced by the high morbidity and mortality associated
Hemorrhage Risk of Cerebral Arteriovenous Malformations Before and During the Latency Period After Gamma Knife Radiosurgery Chun-Po Yen, MD; Jason P. Sheehan, MD, PhD; Lucia Schwyzer, MD; David Schlesinger,
More information7 TI - Radiosurgery of angiographically occult vascular malformations. AU - Kida Y, et al.
1 TI - Cerebral arteriovenous malformation in pregnancy: presentation and neurologic, obstetric, and ethical significance. AU - Finnerty JJ, et al. SO - Am J Obstet Gynecol. 1999 Aug;181(2):296-303. Review.
More informationThe clinical significance of persistent trigeminal nerve contrast enhancement in patients who undergo repeat radiosurgery
CLINICAL ARTICLE J Neurosurg 127:219 225, 2017 The clinical significance of persistent trigeminal nerve contrast enhancement in patients who undergo repeat radiosurgery Seyed H. Mousavi, MD, 1 Berkcan
More informationGamma Knife Radiosurgery
Gamma Knife Radiosurgery A Team Approach to Treating Patients George Bovis, MD Patrick Sweeney, MD Jagan Venkatesan, MS Matt White, MS Illinois Gamma Knife Center Elk Grove Village, IL Disclosures Shareholders
More informationStereotactic Radiosurgery and Stereotactic Body Radiation Therapy
Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy Policy Number: Original Effective Date: MM.05.008 05/12/1999 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 04/01/2015
More informationChapter 28 Emerging Indications in Stereotactic Radiosurgery: The First Application of Cellular Surgery
Chapter 28 Emerging Indications in Stereotactic Radiosurgery: The First Application of Cellular Surgery Douglas Kondziolka, M.D., M.Sc., F.R.C.S.C., L. Dade Lunsford, M.D., John C. Flickinger, M.D., and
More informationMicrosurgical Resection of Incompletely Obliterated Intracranial Arteriovenous Malformations Following Stereotactic Radiosurgery
II-2. Selection of Treatment Microsurgical Resection of Incompletely Obliterated Intracranial Arteriovenous Malformations Following Stereotactic Radiosurgery Steven D. CHANG*, Gary K. STEINBERG*, Richard
More information!"#$%&'()*+,-./01 !"#$ N! !"#$%&'()*+,- !"#$%&'()*+,-)*./01!"#$% &'()*+,-./#0!"#$#%
!"#$%&!"#$ N!!"#$%&'()!" N!!"#$%&'()*+,-./0123456789:;4567 OMN!"#$%!&!"#$%&'!( )*+,-./01!2345678019:;?@!ABC%6 2!"#$%&'()*!+,,-./*012345-678*4509:;?@ABC./$! -.!/0123456*+!789:6;?@A2B!#$6CD
More informationNON MALIGNANT BRAIN TUMOURS Facilitator. Ros Taylor Advanced Neurosurgical Nurse Practitioner Southmead Hospital Bristol
NON MALIGNANT BRAIN TUMOURS Facilitator Ros Taylor Advanced Neurosurgical Nurse Practitioner Southmead Hospital Bristol Neurosurgery What will be covered? Meningioma Vestibular schwannoma (acoustic neuroma)
More informationA lthough more than 90% of intracranial meningiomas are
226 PAPER Complications after gamma knife radiosurgery for benign meningiomas J H Chang, J W Chang, J Y Choi, Y G Park, S S Chung... See end of article for authors affiliations... Correspondence to: Professor
More informationGamma Knife surgery (GKS) was introduced for. Clinical and pathological analysis of benign brain tumors resected after Gamma Knife surgery
J Neurosurg (Suppl 2) 2:79 87, 204 AANS, 204 Clinical and pathological analysis of benign brain tumors resected after Gamma Knife surgery Clinical article Ali Liu, M.D., Jun-Mei Wang, M.D., 2 Gui-Lin Li,
More informationLong term effects of Gamma knife Radiosurgery for treatment of cerebral arteriovenous malformations
Original Research Medical Journal of Islamic Republic of Iran, Vol. 25, No. 3, Nov. 2011, pp. 119-126 Long term effects of Gamma knife Radiosurgery for treatment of cerebral arteriovenous malformations
More informationVestibular schwannomas (acoustic neuromas) are. The newly diagnosed vestibular schwannoma: radiosurgery, resection, or observation?
Neurosurg Focus 33 (3):E8, 2012 The newly diagnosed vestibular schwannoma: radiosurgery, resection, or observation? Douglas Kondziolka, M.D., F.R.C.S.C., 1,2 Seyed H. Mousavi, M.D., 1,2 Hideyuki Kano,
More informationTumor-related trigeminal neuralgia (TRTN) is
clinical article J Neurosurg 125:838 844, 2016 Gamma Knife surgery for tumor-related trigeminal neuralgia: targeting both the tumor and the trigeminal root exit zone in a single session Sung Kwon Kim,
More informationIntracranial arteriovenous malformations (AVMs)
clinical article J Neurosurg 123:945 953, 2015 A quantitative analysis of adverse radiation effects following Gamma Knife radiosurgery for arteriovenous malformations Or Cohen-Inbar, MD, PhD, 1 Cheng-Chia
More informationLong term neuroimaging and clinical outcome of brain Arteriovenous Malformations (bavm) treated with stereotactic radiosurgery (SRS).
Long term neuroimaging and clinical outcome of brain Arteriovenous Malformations (bavm) treated with stereotactic radiosurgery (SRS). Poster No.: C-2489 Congress: ECR 2012 Type: Scientific Exhibit Authors:
More informationSpetzler-Martin Grade III arteriovenous malformations. Radiosurgery for Spetzler-Martin Grade III arteriovenous malformations.
See the corresponding editorial in this issue, pp 955 958. J Neurosurg 120:959 969, 2014 AANS, 2014 Radiosurgery for Spetzler-Martin Grade III arteriovenous malformations Clinical article Dale Ding, M.D.,
More informationLocal control of brain metastases by stereotactic radiosurgery in relation to dose to the tumor margin
J Neurosurg 104:907 912, 2006 Local control of brain metastases by stereotactic radiosurgery in relation to dose to the tumor margin MICHAEL A. VOGELBAUM, M.D., PH.D., LILYANA ANGELOV, M.D., SHIH-YUAN
More informationParaganglioma of the Skull Base. Ross Zeitlin, MD Medical College of Wisconsin Milwaukee, WI
Paraganglioma of the Skull Base Ross Zeitlin, MD Medical College of Wisconsin Milwaukee, WI Case Presentation 63-year-old female presents with right-sided progressive conductive hearing loss for several
More informationStereotactic Radiosurgery and Stereotactic Body Radiation Therapy
Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy Policy Number: Original Effective Date: MM.05.008 05/12/1999 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST 04/01/2014 Section:
More informationGamma Knife radiosurgery with CT image-based dose calculation
JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS, VOLUME 16, NUMBER 6, 2015 Gamma Knife radiosurgery with CT image-based dose calculation Andy (Yuanguang) Xu, 1a Jagdish Bhatnagar, 1 Greg Bednarz, 1 Ajay Niranjan,
More informationbrain talk brain talk IRSA Inside: Definition 2 Radiosurgery: First Choice for Many 3 Management Algorithm 7 SRS and FSR 8 Patient Story 9 Scanning 10
brain talk brain talk An Educational Publication Volume 9, Number 2 ISSN 1086-427X Acoustic Neuroma & Patient Choice Inside: Definition 2 : First Choice for Many 3 Management Algorithm 7 SRS and FSR 8
More informationDisclosures. Neurological Manifestations of Von Hippel Lindau Syndrome. Objectives. Overview. None No conflicts of interest
Neurological Manifestations of Von Hippel Lindau Syndrome ARNOLD B. ETAME MD, PhD NEURO-ONCOLOGY/NEUROSURGERY Moffitt Cancer Center Disclosures None No conflicts of interest VHL Alliance Annual Family
More informationWa i t-a n d-s e e strategy1,2,19 is a classic recommendation
J Neurosurg 113:105 111, 2010 Wait-and-see strategy compared with proactive Gamma Knife surgery in patients with intracanalicular vestibular schwannomas Clinical article Je a n Ré g i s, M.D., 1 Ro m a
More informationCerebellopontine angle (CPA) meningiomas are a. Stereotactic radiosurgery for cerebellopontine angle meningiomas. Clinical article
J Neurosurg 120:708 715, 2014 AANS, 2014 Stereotactic radiosurgery for cerebellopontine angle meningiomas Clinical article Seong-Hyun Park, M.D., Ph.D., 1,3,4 Hideyuki Kano, M.D., Ph.D., 1,3 Ajay Niranjan,
More informationStereotactic Radiosurgery and Stereotactic Body Radiation Therapy
Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy Policy Number: Original Effective Date: MM.05.008 05/12/1999 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 11/20/2015
More informationRadiosurgery and fractionated radiation therapy: comparison of different techniques in an in vivo rat glioma model
J Neurosurg 84:1033 1038, 1996 Radiosurgery and fractionated radiation therapy: comparison of different techniques in an in vivo rat glioma model DOUGLAS KONDZIOLKA, M.D., M.SC., F.R.C.S.(C), SALVADOR
More informationBackground Principles and Technical Development
Contents Part I Background Principles and Technical Development 1 Introduction and the Nature of Radiosurgery... 3 Definitions of Radiosurgery... 5 Consequences of Changing Definitions of Radiosurgery...
More informationFractionated Proton Beam Therapy for Acoustic Neuromas: Tumor Control and Hearing Preservation
Fractionated Proton Beam Therapy for Acoustic Neuromas: Tumor Control and Hearing Preservation Carolyn J. Barnes, MD 1 ; David A. Bush, MD 1 ; Roger I. Grove, MPH 1 ; Lilia N. Loredo, MD 1 ; Jerry D. Slater,
More informationVestibular schwannomas (VSs) are histologically
CLINICAL ARTICLE J Neurosurg 127:1384 1391, 2017 Magnetic resonance imaging characteristics and the prediction of outcome of vestibular schwannomas following Gamma Knife radiosurgery Chih-Chun Wu, MD,
More informationRESEARCH ARTICLE. Clinical Outcomes of Intracranial Nonvestibular Schwannomas Treated with Linac-Based Stereotactic Radiosurgery and Radiotherapy
10.14456/apjcp.2016.87/APJCP.2016.17.7.3271 Linac-Based SRS/FSRT for Intracranial Nonvestibular Schwannomas RESEARCH ARTICLE Clinical Outcomes of Intracranial Nonvestibular Schwannomas Treated with Linac-Based
More informationLong-term control of large pontine arteriovenous malformation using gamma knife therapy: a review with illustrative case
Long-term control of large pontine arteriovenous malformation using gamma knife therapy: a review with illustrative case Martin M. Mortazavi 1, Daxa Patel 1, Christoph J. Griessenauer 1, R. Shane Tubbs
More informationORIGINAL ARTICLE GAMMA KNIFE STEREOTACTIC RADIOSURGERY FOR SALIVARY GLAND NEOPLASMS WITH BASE OF SKULL INVASION FOLLOWING NEUTRON RADIOTHERAPY
ORIGINAL ARTICLE GAMMA KNIFE STEREOTACTIC RADIOSURGERY FOR SALIVARY GLAND NEOPLASMS WITH BASE OF SKULL INVASION FOLLOWING NEUTRON RADIOTHERAPY James G. Douglas, MD, MS, 1,2 Robert Goodkin, MD, 1,2 George
More informationTh e American Association of Neurological Surgeons, Hearing preservation in vestibular schwannoma stereotactic radiosurgery: what really matters?
J Neurosurg J Neurosurg (Suppl) 109:000 000, 109:129 136, 2008 Hearing preservation in vestibular schwannoma stereotactic radiosurgery: what really matters? Mar k E. Li n s k e y, M.D. Department of Neurological
More informationSelected radiosurgery cases from the Rotating Gamma Institute Debrecen, Hungary
Selected radiosurgery cases from the Rotating Gamma Institute Debrecen, Hungary László Bognár M.D., Ph.D., József G. Dobai M.D., Gábor Csiky and Imre Fedorcsák M.D., Ph.D. Department of Neurosurgery, Medical
More informationACOUSTIC NEUROMAS. Being invited to Florence, Italy to address an international medical meeting about our work for
ACOUSTIC NEUROMAS Being invited to Florence, Italy to address an international medical meeting about our work for head and neck tumors was a great honor. The symposium organized under the auspices of the
More informationDr. T. Venkat Kishan Asst. Prof Department of Radiodiagnosis
Dr. T. Venkat Kishan Asst. Prof Department of Radiodiagnosis Schwannomas (also called neurinomas or neurilemmomas) constitute the most common primary cranial nerve tumors. They are benign slow-growing
More informationStereotactic Radiosurgery and Stereotactic Body Radiation Therapy
Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy Policy Number: Original Effective Date: MM.05.008 05/12/1999 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 04/01/2017
More informationSTEREOTACTIC RADIOSURGERY FOR LIMITED BRAIN METASTASES IN IRANIAN BREAST CANCER PATIENTS
STEREOTACTIC RADIOSURGERY FOR LIMITED BRAIN METASTASES IN IRANIAN BREAST CANCER PATIENTS Yousefi Kashi A. SH, Mofid B. 1 Department of Radiation Oncology,Shohada Tajrish Hospital,Shahid Beheshti University
More informationA Population-Based Study on the Uptake and Utilization of Stereotactic Radiosurgery (SRS) for Brain Metastasis in Nova Scotia
A Population-Based Study on the Uptake and Utilization of Stereotactic Radiosurgery (SRS) for Brain Metastasis in Nova Scotia Gaurav Bahl, Karl Tennessen, Ashraf Mahmoud-Ahmed, Dorianne Rheaume, Ian Fleetwood,
More information